Riley Batchelor1, David Hongwei Liu1, Jason Bloom1, Samer Noaman1, William Chan1,2,3,4. 1. Department of Cardiology, Alfred Health, Melbourne, Australia. 2. Department of Medicine, University of Melbourne, Melbourne, Australia. 3. Department of Medicine, Monash University, Melbourne, Australia. 4. Department of Cardiology, Western Health, Melbourne, Australia.
Abstract
OBJECTIVES: To conduct a systematic review and meta-analysis of studies examining the impact of periprocedural intravenous morphine on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). BACKGROUND: Morphine analgesia may reduce the absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of periprocedural intravenous morphine on clinical outcomes in patients undergoing PCI for STEMI is not well defined. METHODS: Analysis of the electronic databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI intravenous morphine use with in-hospital or 30-day myocardial infarction (MI) (primary outcome) and in-hospital or 30-day mortality. RESULTS: A total of 11 studies were included for systematic review. One study was a randomized controlled trial, 10 were observational studies. Five studies including 3,748 patients were included in meta-analysis of in-hospital or 30-day MI. Within this group, patients were treated concurrently with ticagrelor (n = 2,239), clopidogrel (n = 1,256) and prasugrel (n = 253). There was no significant association of in-hospital or 30-day MI with intravenous morphine (odds ratio 1.88; 95% confidence interval [CI] 0.87-4.09; I2 0%). Across seven studies and 5,800 patients, no increased risk of mortality at the same composite time endpoint was evident (odds ratio 0.70; 95% CI 0.40-1.23; I2 19%). CONCLUSIONS: Periprocedural intravenous morphine administration was not associated with adverse short-term clinical outcomes in patients undergoing primary PCI for STEMI. Further randomized trial data are needed to evaluate the pharmacologic interaction between morphine and P2Y12 antagonists with clinical outcomes.
OBJECTIVES: To conduct a systematic review and meta-analysis of studies examining the impact of periprocedural intravenous morphine on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). BACKGROUND:Morphineanalgesia may reduce the absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of periprocedural intravenous morphine on clinical outcomes in patients undergoing PCI for STEMI is not well defined. METHODS: Analysis of the electronic databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI intravenous morphine use with in-hospital or 30-day myocardial infarction (MI) (primary outcome) and in-hospital or 30-day mortality. RESULTS: A total of 11 studies were included for systematic review. One study was a randomized controlled trial, 10 were observational studies. Five studies including 3,748 patients were included in meta-analysis of in-hospital or 30-day MI. Within this group, patients were treated concurrently with ticagrelor (n = 2,239), clopidogrel (n = 1,256) and prasugrel (n = 253). There was no significant association of in-hospital or 30-day MI with intravenous morphine (odds ratio 1.88; 95% confidence interval [CI] 0.87-4.09; I2 0%). Across seven studies and 5,800 patients, no increased risk of mortality at the same composite time endpoint was evident (odds ratio 0.70; 95% CI 0.40-1.23; I2 19%). CONCLUSIONS: Periprocedural intravenous morphine administration was not associated with adverse short-term clinical outcomes in patients undergoing primary PCI for STEMI. Further randomized trial data are needed to evaluate the pharmacologic interaction between morphine and P2Y12 antagonists with clinical outcomes.
Authors: Jacek Kubica; Piotr Adamski; Jerzy R Ładny; Jarosław Kaźmierczak; Tomasz Fabiszak; Krzysztof J Filipiak; Robert Gajda; Mariusz Gąsior; Zbigniew Gąsior; Robert Gil; Jarosław Gorący; Stefan Grajek; Leszek Gromadziński; Marcin Gruchała; Grzegorz Grześk; Piotr Hoffman; Miłosz J Jaguszewski; Marianna Janion; Piotr Jankowski; Zbigniew Kalarus; Jarosław D Kasprzak; Andrzej Kleinrok; Wacław Kochman; Aldona Kubica; Wiktor Kuliczkowski; Jacek Legutko; Maciej Lesiak; Klaudiusz Nadolny; Eliano P Navarese; Piotr Niezgoda; Małgorzata Ostrowska; Przemysław Paciorek; Jolanta Siller-Matula; Łukasz Szarpak; Dariusz Timler; Adam Witkowski; Wojciech Wojakowski; Andrzej Wysokiński; Marzenna Zielińska Journal: Cardiol J Date: 2022-05-06 Impact factor: 3.487